Department of Health Service, PLA General Hospital, Beijing, 100853, China.
Department of Occupational and Environmental Health, and the Ministry-of-Education's Key Laboratory of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Air Force Medical University, No.169, Changlexi Road, Xi'an, 710032, China.
BMC Public Health. 2019 Aug 27;19(1):1170. doi: 10.1186/s12889-019-7515-5.
Though lead (Pb)-gasoline has been banned for decades in China, Pb continues to be a vital risk factor for various diseases. Traditional studies, without large sample size, were unable to identify explicitly the associations among Pb, its disease profile, and the related medical burden. This study was designed to investigate: 1) current status of blood Pb levels; 2) Pb-associated disease profile, medical burden, as well as impact factors.
Research subjects were patients who visited military hospitals and were required to test their blood Pb levels by doctors between 2013 and 2017. The large sample size and area coverage may, to a large extent, reveal the characteristics of Pb exposure in the whole Chinese population. Information of patients' electronic medical records was extracted using Structured Query Language (SQL) in Oracle database. The spatial, temporal, and population distribution of their blood Pb levels were tested, to illustrate the association of Pb exposure with diseases' profile, and medical burden. Non-parametric tests were applied to compare the differences of Pb levels among various groups.
The blood Pb concentration showed a positively skewed distribution by Kolmogorov-Smirnov test (D = 0.147, p < 0.01). The blood Pb concentration of Chinese patients was 28.36 μg/L, with the lowest blood Pb levels, 4.71 μg/L, found in patients from Guangxi Zhuang Autonomous Region, and the highest, 50 μg/L, in Yunnan province. Han Chinese patients' Pb levels were significantly lower than other minorities groups (z-score = - 38.54, p < 0.01). Average medical cost for Pb poisoning was about 6888 CNY for Chinese patients. Pb levels of patients with malignant neoplasm of lung, 45.34 μg/L, were far higher than malignant neoplasm of other respiratory, and intrathoracic organs, 24.00 μg/L (z-score = - 2.79, p < 0.01).
This study reported current status of blood Pb levels for patients who once visited military hospitals, partially representing the whole Chinese population. The result shows that Pb poisoning is still imposing marked economic burdens on patients under Pb exposure. Association of Pb with lung cancer may open up new areas for Pb-induced toxicology. The research strategy may advance toxicological studies in the aspect of medical data mining.
尽管中国已在几十年前禁止使用含铅（Pb）汽油，但 Pb 仍是多种疾病的重要危险因素。由于以往研究的样本量较小，无法明确 Pb 与疾病谱及其相关医疗负担之间的关联。本研究旨在调查：1）目前血液 Pb 水平状况；2）与 Pb 相关的疾病谱、医疗负担以及影响因素。
研究对象为 2013 年至 2017 年间在军队医院就诊并经医生要求检测血液 Pb 水平的患者。该研究的大样本量和区域覆盖范围在很大程度上揭示了全中国人群中 Pb 暴露的特征。使用 Oracle 数据库中的结构化查询语言（SQL）提取患者电子病历信息。检测血液 Pb 水平的时空和人群分布，以说明 Pb 暴露与疾病谱和医疗负担之间的关联。采用非参数检验比较不同组间 Pb 水平的差异。
Kolmogorov-Smirnov 检验（D=0.147，p<0.01）表明血液 Pb 浓度呈正偏态分布。中国患者的血液 Pb 浓度为 28.36μg/L，其中广西壮族自治区患者的血液 Pb 浓度最低，为 4.71μg/L，云南省患者的血液 Pb 浓度最高，为 50μg/L。汉族患者的 Pb 水平明显低于其他少数民族群体（z 得分=-38.54，p<0.01）。中国 Pb 中毒患者的平均医疗费用约为 6888 元人民币。肺癌患者的血液 Pb 浓度（45.34μg/L）远高于其他呼吸系统和胸内器官恶性肿瘤患者（24.00μg/L）（z 得分=-2.79，p<0.01）。
本研究报告了曾就诊于军队医院的患者的血液 Pb 水平现状，部分代表了全中国人群。结果表明，Pb 暴露仍给患者带来显著的经济负担。Pb 与肺癌的关联可能为 Pb 诱导的毒理学开辟新领域。该研究策略可能会推动医学数据挖掘方面的毒理学研究。
